Understanding the Side Effects of Treatment for Hodgkin and Non-Hodgkin Lymphomas

The goal of treatment for Hodgkin
lymphoma is to cure the
patient. Chemotherapy or a
combination of chemotherapy and radiation
can result in cures. Over 75
percent of all people diagnosed with
Hodgkin lymphoma can be cured by
current treatment approaches. The goal
of treatment for non-Hodgkin lymphoma
is to destroy as many malignant
cells as possible and to induce a complete
remission, that is, to eliminate all
evidence of disease. In some cases in
which this goal is accomplished, a cure
may be achieved.

People undergoing treatment for
lymphoma may experience some possible
side effects. When side effects
do occur, most are short-lived and disappear
when therapy is completed. In
recent years, new drugs have increased
physicians? ability to control certain
side effects, such as nausea and vomiting,
which used to be very troubling for
many people. The benefit of treatment,
with its goal of remission and, in some
cases, cure, outweighs the risks, discomfort,
and unpleasantness in most cases.

Early Effects of Treatment The
side effects of treatment for lymphoma
depend on the intensity and type of
treatment, such as the location of the
radiation therapy, the age of the person,
and coexisting medical conditions (for
example, diabetes mellitus, chronic
renal disease, and others). In addition,
certain drugs have a specific tendency
to affect certain tissues. Two examples
are the tendencies for vincristine to
affect nervous tissue and bleomycin
to affect the lungs.

Suppressed Blood Cell Formation
Decreases in blood cell counts may occur
in people treated with chemotherapy.
Blood transfusions may be necessary
for some people with low blood cell
counts. If decreases in white cell counts
are severe and continue for extended
periods, infection may develop and require
antibiotic treatment. Sometimes,
doses of chemotherapy or the time between
chemotherapy cycles must be
altered to allow the person's blood counts
to recover from the effects of treatment.

When side effects do occur, most are short-lived and
disappear when therapy is completed.

Oral and Gastrointestinal Effects
Treatment for the lymphomas may
cause mouth sores, nausea, vomiting,
diarrhea, constipation, bladder irritation,
and blood in the urine.

Other EffectsTherapy can induce
extreme fatigue, fever, cough, lung
function impairment, and cardiac function
impairment. People undergoing
treatment for lymphoma also may experience
rashes; hair loss; weakness;
nerve function impairment ranging from
tingling sensations to, infrequently,
more serious impairment of function;
and other effects. These diverse effects
depend on the drugs and dosages used
and the individual's susceptibility.

Effects on Fertility Some people
may have a decrease in fertility after
treatment. The risk of infertility varies
according to the nature of the treatment,
depending on the type and amount of
chemotherapy, the location of radiation
therapy, and the person's age. Men
who are at risk of infertility can consider
sperm banking. Women who
have ovarian failure after treatment will
have premature menopause and require
hormone replacement therapy. When
childbearing is possible, whether the
male or the female partner has received
treatment, the incidence of fetal loss
and the health of the newborn are very
similar to those of healthy couples.

Late Effects of Treatment There
is an increased risk of secondary cancers
in people treated for Hodgkin
lymphoma and non-Hodgkin lymphomas.
Radiation therapy has been
associated with cancers of the breast,
lung, stomach, bone, and soft tissues.
Often, they occur many years after
treatment. Radiation therapy to the
chest has been associated with various
types of heart disease, including inflammation
of the surrounding sac
(pericardium) or myocardial infarction
(classic heart attack). Injury to the thyroid
gland may cause decreased thyroid
gland function (hypothyroidism), and
injury to the lung may follow radiation
therapy. Advances in radiotherapy
have decreased the frequency of side
effects, but these may still occur in
people who have been treated in past
decades. Exposure to chemotherapy
has been associated with an increased
incidence of myelogenous leukemia.

The process of making choices about
chemotherapy and other treatment options
can cause a great deal of anxiety.
Often, if people with blood cancers
talk to their healthcare providers about
the medical questions they have, including
how to deal with side effects, they
feel some sense of relief in making
treatment choices. In addition, your
physicians, nurses, social workers, and
other health professionals understand
the complexity of emotions and special
needs of those undergoing treatment.
They are available to spend time with
you, answer questions, lend emotional
support, and provide referrals to other
useful resources.

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Excerpted with permission from The Lymphomas:
Hodgkin Lymphoma and Non-Hodgkin Lymphomas,
copyright by the Leukemia & Lymphoma Society,
www.lls.org.

This article was published in Coping® with Cancer magazine,
July/August
2008.